Modified Irinotecan Plus Cisplatin and Dexamethasone (ICD) Combination Chemotherapy as Salvage Chemotherapy for Patients with Relapsed/Refractory Diffuse Large Cell Lymphoma

Abstract

About 50 % of patients with diffuse large cell lymphoma are candidate for salvage chemotherapy followed by bone marrow transplantation in the selected patients. In the current study we evaluated modified ICD (Irinotecan, Cisplatin, and Dexamethasone with G-CSF support) as salvage chemotherapy in the patients previously treated with R-CHOP or CHOP. In a retrospective study we evaluated 16 patients treated with modified ICD: irinotecan 65 mg/m 2 (max 100 mg)/day plus cisplatin 30 mg/m 2 (max 50 mg)/ day and dexamethasone 40 mg/day on days 1 and 8. Prednisolone 200 mg divided in 2 doses was given orally on days 2 and 9. G-CSF (PDgrastim) was administered at 300 lg/day subcutaneously on days 4-6 and 11-13. pre-and posthydration was given according to our hospital protocol. Overall response rate was 75 % for all of the patients and 90 % for the patients treated as first line salvage. The median overall survival was 23 ± 12 months. There was no grade 3/4 of neutropenia and no cycles of chemotherapy were delayed due to leucopenia. Modified ICD might be an effective salvage regimen for refractory/relapsed lymphoma patients. Unlike original ICD, leucopenia does not seem to be a limiting factor. So we conclude that modified ICD shall be considered as a safe and effective regimen for salvage chemotherapy in refractory/relapsed patients.

Assessment of Effectiveness and Adverse Effect of New Combination Chemotherapy (irinotecan, cisplatin, and dexamethasone) in Relapse and Refractory Hodgkin Lymphoma

“…In 2002, a case report on the efficacy of Irinotecan in relapsed Hodgkin lymphoma demonstrated that Irinotecan has a therapeutic effect in patients with relapsed Hodgkin's lymphoma 18 . Moreover, Ghadiany et al evaluated the efficacy of Irinotecan in relapsed or refractory non-Hodgkin lymphoma 9 , 10 and Niitsu et al evaluated the efficacy of Irinotecan in relapsed or refractory peripheral T‐cell lymphoma with good results 19 . Therefore, we evaluated the effect of Irinotecan in combination with cisplatin and dexamethasone on Hodgkin lymphoma patients with promising results and low toxicity.…”

“…Irinotecan is a topoisomerase-I inhibitor and is used in many tumors. Ghadiany et al and Kang et al evaluated the efficacy of Irinotecan in relapsed or refractory non-Hodgkin lymphoma with an ORR of 81% and 71%, respectively 9 , 10 . Niitsu administered Irinotecan in combination with Mitoxantrone and dexamethasone in relapsed or refractory peripheral T‐cell lymphoma with an ORR of 60% 19 .…”

“…In Kuruvilla et al study, GDP (Gemcitabine, Dexamethasone, and Cisplatin) as second-line therapy in patients with R/R HL showed a 62% response rate 8 . In two studies by Ghadiany et al 9 and Kang et al 10 , ICD (Irinotecan, Cisplatin, Dexamethasone) was evaluated in refractory non-Hodgkin lymphoma patients previously treated with R-CHOP or CHOP or as first salvage treatment. Overall, all patients achieved a 71% to 75% response rate, but surprisingly patients treated as first-line salvage achieved an overall response rate of 90% 9 , 10 .…”

“…In two studies by Ghadiany et al 9 and Kang et al 10 , ICD (Irinotecan, Cisplatin, Dexamethasone) was evaluated in refractory non-Hodgkin lymphoma patients previously treated with R-CHOP or CHOP or as first salvage treatment. Overall, all patients achieved a 71% to 75% response rate, but surprisingly patients treated as first-line salvage achieved an overall response rate of 90% 9 , 10 . However, in the Kang study, the high prevalence of neutropenia was a limiting factor.…”